ProMedica Health System, based in Toledo, Ohio, is a not-for-profit organization that serves communities in 28 states. The health system offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines.

The organization has more than 43,000 employees, 12 hospitals, 2,500 physicians and advanced practice providers with privileges. The health system also has 1,000 healthcare providers employed by ProMedica Physicians, a health plan, and 335 assisted living facilities, skilled nursing centers, memory care communities, outpatient rehabilitation clinics, and hospice, palliative and home health care agencies.

THE PROBLEM

A common clinical need across the health system's footprint is how to continue patients' access to critically important specialty-based care, both for chronic condition management in the ambulatory setting and for acute care needs within the hospital setting.

ProMedica's clinical footprint is massive, including suburban and rural catchment areas with care focused on smaller community hospitals. But the bulk of the network specialists are concentrated in a metro area of northwest Ohio.

The challenge is always how to distribute that needed care in the most efficient manner for the specialist clinicians, in a way that best optimizes their time while enhancing that patient experience and value.

PROPOSAL

The telemedicine technologies staff proposed were twofold.

"First, in our ambulatory settings, many specialists still need the patient to appear in a clinical setting for in-person data vitals collection and specialty-based office testing," explained Dr. Brian Miller, chief medical informatics officer and vice president of the telehealth institute at ProMedica Health System.

"As a result, we proposed a clinic-to-clinic tele-workflow whereby the patient would be seen in a regional/rural clinic by trained medical staff, and the physician would remotely attend by audiovisual means to review, examine and consult on the patient's care," he added.

"With only around 1,500 of these high-risk obstetric specialists available nationwide, access to this critical care can be very difficult for pregnant women, and especially so in this population where that care often is complicated by social determinants of health issues as well."

Dr. Brian Miller, ProMedica Health System

In the hospital settings, staff proposed expanding the small fleet of inpatient tele-carts, reserved at the time primarily for tele-stroke utilization, while also adding diagnostic tools to the cart (such as stethoscopes and otoscopes) so the various specialists could attend at the bedside remotely using the audiovisual capabilities.

"The multi-user functionality of the platform also allowed other physicians or even family members to participate in the visit, enhancing the value and experience," Miller noted.

MARKETPLACE

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MEETING THE CHALLENGE

In the ambulatory space, the first specialty ProMedica tackled was materno-fetal medicine (MFM).

"With only around 1,500 of these high-risk obstetric specialists available nationwide, access to this critical care can be very difficult for pregnant women, and especially so in this population where that care often is complicated by social determinants of health issues as well," Miller said.

"We created regional MFM clinics around our rural hospitals, fully equipped with high-resolution obstetric ultrasound machines, and allowed our MFM providers to work from their base clinic in our metro region to provide live care and advice for those patients within a platform that is fully integrated in the system EHR," he continued. "This dramatically reduced their non-productive 'dashboard time' while also expanding the total number of patients they could see in a week."

In ProMedica's acute care space, staff combined the technology expansion of the tele-cart fleet with an integrated order and documentation within the EHR for specific virtual consult services within six regional hospitals. In this space, the staff and specialists were trained on the most efficient and compliant workflows required.

"This included training the providers on the mobile application for the platform so they could more quickly attend to inpatient needs while on the go between their offices and other hospitals," Miller said. "So far, we've expanded that service broadly into the specialties of hospitalist, neurology, infectious disease and oncology, expediting care to hundreds of critically ill patients across our inpatient footprint."

RESULTS

Based on this work, ProMedica has been able to double its offering of inpatient virtual service lines from three to six services, expanding and expediting care access to hundreds of inpatients for specialty-based services.

"By year's end, we'll be adding pulmonary and critical care services to that list, as well as expanding specialty services across the organization to our even broader multistate footprint of skilled nursing facilities for neurology, wound and infectious disease care," Miller said.

"Our number of ambulatory MFM regional clinics now stands at five, expanding to seven locations by year's end, allowing hundreds of obstetric patients to get the appropriate level of quality care oversight for their high-risk condition while also remaining in their community for their routine obstetric care and delivery," he continued. "This clinic-to-clinic workflow also will be expanding to other services this year, including pulmonary and oncology."

USING FCC AWARD FUNDS

ProMedica Health System was awarded funds by the FCC telehealth award program for telemedicine carts, remote monitoring equipment and videoconferencing software to provide the option of telehealth visits for patients in response to the COVID-19 pandemic and to ensure clinician safety.

"The FCC telehealth award funds were critical for us at the start of the COVID-19 pandemic to rapidly roll out the technology, hardware and platforms required to deliver to the abrupt shift to tele-care that was required," Miller recalled.

"We secured more than $1 million in funding to ultimately deploy more than 1,000 fully functional tele-carts and tablet devices to 20 hospitals and more than 300 skilled nursing facilities so patient access to providers and care would not be interrupted," he continued.

Just as important, these devices also provided a necessary lifeline for patients to stay connected to their support network of family, friends and loved ones who no longer could safely visit in person.

"As we shift away from pandemic-response mode into our new future of telecare, that large infrastructure will be critically important to build out more innovative models of virtual care so that we may drive more access, quality and efficiency for our care models while enhancing the patient experience and value," Miller concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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